Patterns of relapse in older women diagnosed with estrogen receptor (ER)–positive early-stage breast cancer (BC) treated with lumpectomy without adjuvant endocrine therapy (ET)
- 17 Downloads
Randomized trials comparing endocrine therapy (ET) with no ET show reduced overall relapse rates with adjuvant ET for patients with early-stage estrogen receptor (ER)–positive breast cancer (BC). Of note, these studies include few patients over the age of 65 years. Currently, with ET routinely prescribed, there is limited opportunity to study the patterns of relapse without ET. The objective of our study is to evaluate the rates of local-regional and distant relapse in older BC women who postoperatively did not receive ET.
In this retrospective study, we identified 92 patients who did not receive ET after lumpectomy in our database of 1172 patients’ age 65 years or older (median age 75 years) with ER-positive, node-negative BC. Following lumpectomy, 37 patients (40%) received radiation therapy (RT) and 55 patients (60%) were observed.
Median follow-up for the entire cohort is 65.5 months, and the 5-year overall survival rate is 89.3%. The 5-year relapse-free survival rates with lumpectomy + RT and lumpectomy alone are 97% and 84%, respectively (p = 0.008). One of 37 patients treated with lumpectomy + RT developed a local recurrence (3%), and no distant relapse was observed. Among patients treated with lumpectomy alone, 8/55 (15%) had a local relapse and one patient (2%) experienced distant relapse.
Patterns of relapse in older women with ER-positive early-stage BC note that local relapse is the most common site of failure. In this study, we also observed a low risk of distant relapse among patients not receiving ET. These observations on relapse patterns suggest that older women with early-stage BC may derive more benefit from adjuvant RT alone and be spared the potential side effects of ET.
KeywordsEarly-stage breast cancer Lumpectomy Older women Endocrine therapy Antiestrogen therapy Breast radiation
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Research involving human participants and/or animals
All co-authors gave their informed consent prior to their inclusion in the study.
- 2.Autier P, Boniol M, Koechlin A, Pizot C, Boniol M (2017) Effectiveness of and over diagnosis from mammography screening in the Netherlands: population based study. BMJ 359. https://doi.org/10.1136/bmj.j5224
- 3.https://www.nccn.org/professionals/physician_gls/default.aspx#breast. BINV-2, footnote u, Breast Cancer version 3.2018; accessed November 19, 2018
- 5.Hughes KS, Schnaper LA, Bellon JR et al (2013) Lumpectomy plus tamoxifen with or without irradiation in women age 70 years or older with early breast cancer: long-term follow-up of CALGB 9343. J Clin OncolGoogle Scholar
- 6.Kunkler IH, Williams LJ, Jack WJL et al (2015) Breast-conserving surgery with or without irradiation in women aged 65 years or older with early breast cancer (PRIME II): a randomized controlled trial. Lancet OncolGoogle Scholar
- 13.Blamey RW, Chetty U, Bates T et al (2008) Radiotherapy and/or tamoxifen after conserving surgery for breast cancers of excellent prognosis: BASO II trial. Eur J Cancer 6(suppl):55Google Scholar
- 15.Harris LN, Ismaila N, McShane LM et al (2016) on behalf of the American Society of Clinical Oncology. Use of biomarkers to guide decisions on adjuvant systemic therapy for women with early-stage invasive breast cancer: American Society of Clinical Oncology practice guideline. J Clin Oncol 34:1134–1150CrossRefGoogle Scholar
- 16.Chia SKL (2018) Review Article: Clinical application and utility of genomic assays in early-stage breast cancer: key lessons learned to date. Curr Oncol 25. https://doi.org/10.3747/co.25.3814